To evaluate the efficacy of the combined approach of preoperative endovascular embolization (EE) and surgical excision (SE) for scalp arteriovenous malformation (AVM) and present an illustrative case report.
A systematic review was conducted using online databases (PubMed/Medline, Cochrane, and Embase) on February 15, 2023. The inclusion criteria were any type of study of patients with scalp AVMs who were diagnosed and confirmed through angiography and treated with combined preoperative EE and SE. All the articles that met the inclusion criteria were included in this study.
A total of 49 articles (91 patients) were included. The patients\' age ranged from 10 days to 70 years at the time of presentation. The most common symptoms were a pulsatile mass in 51 patients (56.04%), progressively growing mass in 31 patients (34.06%), and bruits and/or thrills in 22 patients (24.17%). Complications of preoperative EE and SE were observed in only 5 patients; 3 patients (3.29%) had harvested skin graft marginal necrosis, 1 patient (1.09%) had skin necrosis, and 1 patient (1.09%) had a wound infection. Only 2 patients (2.19%) reported a recurrent or residual mass during a median follow-up period of 12 months.
The management of scalp AVMs can be challenging; therefore, focused, and accurate identification of the complexity of the vascular anatomy is required. The combined method of preoperative EE and SE showed satisfactory outcomes with low rates of complications and recurrence; thus, we recommend this approach for the management of scalp AVMs.

BACKGROUND: Cirsoid aneurysms, also known as arteriovenous malformations (AVMs), of the scalp are relatively rare lesions. They may be found incidentally or with symptoms such as an enlarging pulsatile mass, headache, or bleeding.
METHODS: This retrospective case series comprised 10 cases of scalp AVMs that were treated with surgical excision from January 2010 to January 2020. Diagnosis was made with simple palpation and computed tomography angiography. Scalp AVMs were categorized according to the Schobinger classification.
RESULTS: There were 10 patients, 8 males and 2 females, with a mean age of 22.6 years (range, 10-40 years). All patients underwent ligation of the feeding artery with total excision of the AVM. There were no postoperative complications or recurrences during a mean follow-up of 21.6 months.
CONCLUSIONS: Preoperative embolization reduces vascularity and helps in easy identification as well as complete excision of cirsoid aneurysms during surgery. However, surgical excision alone of cirsoid aneurysms also results in excellent outcomes.

Scalp cirsoid aneurysm is an arteriovenous fistula of the scalp that is unconnected by intracranial or cerebral vessels. Variceal dilatation of draining veins can produce cosmetic concerns, masses, local pain, palpable thrills, and audible bruits, headache, tinnitus, and hemorrhage. Its etiopathogenesis is not well understood. Treatment includes surgery (fistula repair by simple surgical ligation until gross total resection), embolization (whether percutaneous or endovascular), or a combination of the two. An updated systematic review of the last 10 years publications was performed. Also, we report an illustrative case of a young boy with posttraumatic cirsoid aneurysm and good documentation on head vascular examinations, treated by multiple routes (percutaneous embolization with coils and endovascular embolization with cyanoacrylate) with a decrease of the pulsatile mass. A plastic surgery team performed gross total resection, and the final esthetic result was extremely satisfactory.

BACKGROUND: Scalp arteriovenous malformations, also known as cirsoid aneurysms, are rare lesions that are congenital, traumatic, or postinfectious in nature. These lesions may be found incidentally or owing to signs and symptoms that they produce, such as an enlarging pulsatile mass, headache, tinnitus, or bleeding. These lesions often constitute high-flow arterial blood from the superficial temporal or occipital arteries with venous outflow into extracranial venous structures.
METHODS: We describe diagnosis and management of 2 cases of congenital scalp arteriovenous malformations in adolescent patients. One case had more typical vascular supply and outflow, whereas the other case demonstrated more uncommon arterial blood supply from extracranial ophthalmic arteries as well as a component of transosseous venous drainage into the intracranial superior sagittal sinus via emissary veins.
RESULTS: Treatment of these lesions usually consists of endovascular embolization followed by surgical resection.
CONCLUSIONS: Both scalp AVMs described were successfully excised after transvenous embolization. Consideration of risks of intracranial venous drainage must be taken into account when evaluating AVM anatomy.